Psychiatric Evaluation

Unless otherwise indicated, all answers are from the Practice Guideline on this topic, AJP

Supplement, June, 2006As of 11Sep08

Limited English Proficiency

Q. What about the use of family members when working with a pt with limited English proficiency?

Limited English Proficiency

Ans. To be avoided unless pt refuses to allow interpreters or under emergency conditions. Be sure to so note the use of family members in the note and the reason why they were used.

Comprehensive and accurate information

Q. Under what circumstances will one obtain the most comprehensive and accurate information in the initial interview?

Comprehensive and accurate

Ans. Combination of:

1] Open-ended questions with empathy

2] Structured inquiry about specific symptoms and events.

Agitated pt -- room

Q. Desirable interview room arrangement with an agitated pt?

Agitated pt -- room

Ans.

1] both have access to door

2] several arm lengths space between pt and examiner

3] no dangerous objects in the room

4] a mechanism for asking for assistance

5] no personal objects that can be used by pt to harm examiner, e.g. necktie.

Agitated pt – affect management

Q. What does affect management consist of?

Agitated pt – affect management

Ans.

1] Allow pt to ventilate

2] Avoid logical responses that are likely to inflame

3] Validate the affect.

Agitated pt – suggesting dangerousness

Q. What are some things to watch for as to signs the interview is getting more dangerous?

Agitated pt – signs suggestingdangerousness

Ans.

1] restlessness increasing

2] desire to pace

3] clenched fists

4] increased voice tone

5] threatening content of speech

Beck v. Hamilton

Q. How does the Beck Depressive Inventory differ from the Hamilton Depression Rating as to self-reporting?

Beck v. Hamilton

Ans. Unlike the Hamilton, the Beck can be self-reported by the pt.

PANSS

Q. What is the PANSS?

PANSS

Ans. Measures positive and negative signs of schizophrenia.

Neuropsychological testing

Q. What are uses of neurological testing?

Neuropsychological testing

Ans. “Clinical judgment” as to whether to so request. Not part of any DSM-IV criteria. May be helpful with:

1] Need to grade cognitive deficits or follow the progression of those deficits.

2] Differential dx with malingering or factitious disorders – or other psychiatric disorders.

HIPAA

Q. What is HIPAA?

HIPAA

Ans. Health Insurance Portability and Accountability Act.

HIPAA: fed v. state

Q. Under HIPAA, what is status of state laws that are more restrictive than HIPAA?

HIPAA: feds v. state

Ans. More restrictive state law takes precedent.